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General NPI Number Information
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NPI Number | 1477831576
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Entity Type | Organization
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Legal Business Name | THE KING'S OUTREACH MINISTRY
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 7330 OLIVE BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63130-1701
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Country | US
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Telephone | 314-725-8116
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Fax | 314-727-7015
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Provider Business Mailing Address
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Address Line | 7330 OLIVE BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63130-1701
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Country | US
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Telephone | 314-725-8116
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Fax | 314-727-7015
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. CAROL MITCHELL
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Credential |
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Telephone | 314-727-7015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 960
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License Number State | MO
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